Week 3 Learning Worksheet: Global Health Governance

Learning Objectives

• Understand key frameworks for global health governance (actors, functions, legitimacy) and how power is distributed among different stakeholders
• Examine current debates about the future of aid and global health institutions in an era of declining donor funding
• Explore Africa-specific governance shifts and their implications for self-determination in global health
• Critically assess how governance structures shape outcomes for health priorities and whose voices are heard

Pre-Session Reflection

Global health involves multiple actors beyond national governments. In your view, who should have the most influence in setting health priorities (donors, multilateral agencies, national governments, local NGOs, communities)? Why?

[Your response here]

Required Readings

• Frenk J and Moon S. "Governance Challenges in Global Health" — Pages 936-942
• Key framework and concepts for understanding global health governance — who governs, how, and with what legitimacy.
• "Big Aid Is Over" by Kevin Starr, Stanford Social Innovation Review
• Provocative argument about why the traditional aid model is failing and what should replace it.
• "A New Compact for Health Financing: Donor Priority Setting" — Center For Global Development
• Analysis of risks from declining U.S. aid and what a new financing architecture might look like.
• The High Cost of Pausing Life-Saving Aid | Center For Global Development

Africa-specific:

• "Global Health and the 'Second Independence of Africa'" — Think Global Health
• How African countries are asserting greater control over their health agendas and what this means for global health architecture.
• Building a New Public Health Order in Africa — Think Global Health

Optional Readings

• "The Challenge of Localization" — Center For Global Development
• Examines tensions between calls for locally-led development and current power structures in global health.
• "How to Save Twenty Million Lives" — Interview with Dr. Mark Rybul, Statecraft.pub
• PEPFAR case study on what enabled success in the largest global health program in history.
• America First in Global Health: How Africa Should Respond — Ebere Okereke, Think Global Health (2025).
• Direct engagement with the post-USAID America First strategy. Argues for collective negotiation, accelerated domestic investment.

Understanding Global Health Governance

1. According to Frenk & Moon, what makes global health governance especially challenging compared to national health governance? Of the three governance functions they identify, which do you think is hardest to deliver in the current architecture, and why?

[Your response here]

2. In "Big Aid is over", Starr is deeply critical of traditional aid projects and NGO delivery outside government systems. He argues these create parallel systems that disappear when funding ends, and that NGOs often think governments are "scaling their idea" when governments just think they're "getting free services." Do you agree that building projects outside government structures is inherently flawed? Or are there situations where parallel NGO delivery is justified or even necessary?

[Your response here]

3. The "Second Independence of Africa" piece, the CGD "New Compact" piece, and "High Cost of Pausing Life-Saving Aid" present specific risks from declining U.S. aid. What financing or governance reforms do they propose, and what assumptions about donor-recipient relationships do those reforms preserve or challenge?

[Your response here]

Post-Meeting Reflection

What was the most surprising or provocative perspective you heard in today's discussion?

[Your response here]

What governance questions would you like to explore further (e.g., financing mechanisms, African regional bodies, WHO reform)?

[Your response here]

Feedback form: Please fill in the feedback form linked here.